Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

Area of Science:

• Public Health
• Infectious Disease Prevention
• Pharmacology

Background:

• Antiretroviral medication, pre-exposure prophylaxis (PrEP), is a vital strategy for HIV prevention.
• Existing PrEP access barriers are common across different drug types, formulations, and delivery systems.
• Understanding these barriers early is crucial for developing effective future PrEP interventions.

Purpose of the Study:

• To propose essential considerations for the drug development process of future PrEP interventions.
• To identify and analyze key barriers to PrEP uptake in the United States.
• To offer potential solutions to overcome identified challenges.

Main Methods:

• Literature synthesis of key barriers to PrEP uptake in the US.
• Categorization of challenges into structural barriers: provider/clinic characteristics, cost, and social constructs.
• Analysis of commonalities across various PrEP agents and delivery methods.

Main Results:

• Identified three primary categories of structural barriers to PrEP access.
• Provider and clinic characteristics pose significant challenges.
• Cost considerations and social disparities, including social constructs, are major impediments to PrEP uptake.

Conclusions:

• Early consideration of structural barriers in the drug development pathway is essential.
• Addressing provider/clinic factors, cost, and social disparities can enhance PrEP accessibility.
• Proactive strategies to overcome these barriers before regulatory approval can significantly improve PrEP's impact on the HIV pandemic.